WONDERS OF SURGERY.

Press, Volume LIX, Issue 17856, 31 August 1923, Page 12

WONDERS OF SURGERY.

NEW BONES IN OLD BODIES.

THE MONKEY GLAND. CURE.

(nox ora owx coßMsroxDMrr.) LONDON, July 20. World-famous surgeons aro taking part in the sixth triennial congress of the International Surgical Society which was opened by the Prince of Wales this week. Before entering the Congress Hall the Prince signed the roll of honorary members of the Royal Society of Medicine, and the president (Sir W. Mace wen) presented him with the gold badge of the Society, which the Prince pinned on to his morning coat. In his presidential address Sir W. Macewen dealt with "The- Study of Nature as Shedding Light on the Structure and Functions of Man." In this he referred to bone-grafting, and said that young growing nudo bone might be transplanted and would live and grow in its new situation, and would form part of the body of man, becoming homogeneous with him. Forty years ago that was demonstrated and since then bone-grafting and transplanting had been, frequently employed, especially during and since the war. For the restoration of the lower iaw grafting and transplanting of bone had been frequently and successfully employed by many surgeons, restoring thereby the symmetry of the face, and, with the help of the dentist/ the functioning of the lower jaw.

Ductless Glands. The first discussion in the technical section centred on the ductless glands. Professor Veau (Paris) announced as a demonstrable fact that surgeons, by removing the thymus gland, had saved children from otherwise certain death. The surgeons had no sooner conquered this new kingdom than the X-ray experts had claimed that they could produce equally good results without the intervention of the knife. X-rays, however, were occasionally followed by fatal accidents, and though he knew that he was followed by a colleague who was going to advocate the claims of surgery, he argued that the duty of the surgeon was merely to hold a watching brief, and only to intervene in those caies where the knife was essential. The knife should be the last resort. He welcomed the use of X-rays because thus the question of accurate diagnosis that present terrible difficulties was greatly simplified. Dr. Mayo and the Spleen.

Dr. W; Mayo (head of the famous Mayo Clinic at. Rochester) seemed rather to chide Nature for having endowed man with a spleen. It was an organ that could be removed without danger in adult life, and there were cases on record where normal persons had lived normal live 3 without possessing the organ. He wa9 inclined to believe that one of the main functions of the spleen.was to remove from the blood ineffective blood corpuscles, and it was questionable whether m this connexion it did not do more harm than good, because the body might be supplying the best corpuscles of whose manufacture it was capable. In such cases the removal of the spleon might be beneficial to the patient. Dr. Mayo brought before the Society a detailed aeries of cases that will. prove of intense interest to experts. . . The Modest Discoverer of Insulin.. Dr. Banting, the discoverer, of the insulin-cure for diabetes, i 3 so modest that he allowed himself les3 than-two. minutes to describe his work to the Congress. There was an expectant hush, as a -short, clean-shaven man, with large, round, gold-rimmed spectacles rushed breathlessly on to the stage. ' He was overcome with shyness. Ho clasped hia notes behind his; back, fixed hia eyes on the ceiling, and began a rapid monotone of technicality. "There is a noticeable insufficiency of pancreatic extract in diabetio patients," he plunged into his subject without preface. References to inisulin followed in a. tired, uninterested voice.. They were unintelligible to the layman. There was no hint of enthusiasm in his tone. He showed how insulin could be utilised for purposes of surgery, it having been possible to practise major operations on diabetics after treatment with ins'ulin successfully. Aftjer insulin treatment it had; proved possible to remove tho appendix, ,the gall bladder, and gangrenous limbs with very little intervention of surgical 6hock. ■*

Rejuvenation with Monkey Gland. Dr. Serge Voronoff, well known for his monkey-gland treatment, spoke in rapid French, and seemed to be aflame with the intensity of hia concentration on his subject. I>r. Ivor Back (London) supported Dr. Voronoff's contentions. ''l have seen and talked to Dr. Voronoff's patients," he said. "Four or five wo .r« physicians and educated men. Without exception they gave such convincing accounts of his success that it cannot be due to auto-suggestion, as has been suggested. It Is a great scientific advance, and should be further investigated." Dr. Back showed photographs of a ram before and after treatment by Dr. Voronoff. It was originally an amazingly ancient, hang. ??$ W ,?*? hair ™» f alhng out "S in n life, ana%ould haidly stand up. Glands were removed' IT a un & fri , ram » «d in a few months the old ram would have done credit to any Royal Show. The Photo showed a very different creature. Goats were even better patients. Dr. th« lf°v detai r ls - of technique of riL?£T W P is - a &im &° one, but SK^^ii ßß^*8 - Th« old under ii^t re J u ™»ted is put unaer an anesthetic on one table. Beenkwv a SmaUer tablß is »* «■ Mobilising Fixed Joints.

aarihiff *?{!? ting di ?° us ßion ensued re. «>f joinTO<£L y f ur &«£- processes an illuminating ««.i, ' ? there was tween Zma $ chjmge of vi ewa begave the ObSL ?kf ~A m€rica , who experience T % I * B of th « r (Bristol) defined ar+fc i H ! y Owves operative mSSf II 4 rUiro P last ar as an pint with tKbW* UP ?° an "Closed J»*y. OUnical 2&£ mobsuit was conSfcS* 31 " M to^ts Mevidenoe that odmSw.™*. £■» ample the elbow wK^, moblli sation of greatly improved tTF* foll(Wed by la«ty for the hi Arthrop! other hand, o ft£ U? + kD€ ?> <>* *& xnent. *. Wl€a J ea to disap po int■B'on " considerable who gf* to this operation P^ta^ on in reed it in 142 eases s n^L h T av,n g performit was a long andT® June > «W, said tion, and should onl, atlsln 8 operathe case of patients „h resort «d to in ably disposer from *v° w - €re &W organic resistance -rS of able age was between & favonrwas absolutely iffiL 20 * n d 50. It patient, with 'lfcJSgftt, that *£ .should co-operate with+i and « n ergy, sequently tney B fflft doctor - «& on subjects either wi er .operate neuropathic or irritahU rßenss ble or deficient. Neither should tL. m ? ntall y questoou of an operate, «g

patient's means did not allow; a prolonged stage in a hospital. The profession or" calling of the patient must be also taken into account. The delegates were greatly interested in films displayed by Dr< Putti in illustration of his address. In a wonderfully clear manner were shown the various stages of the operation, the film enabling the laymen to realise the extent to which the cinematographic art was capable of being yoked to th« service of the higher surgery. What made the demonstration doubly interesting was that the patient seen in the film was actually with Dr. Puttt on the platform, the lecturer having brought four of nis patients as ocular evidence of the success of the operation. ...

Nerve Injuries. Next came a consideration of nerve injuries, and successive speakers were forced to admit that, despite their utmoßt efforts, and though the Burgeons who spoke were able to claim successes, there were many disheartening failures to record. Professor A. Gosset (Pans) told how he had used a dog's scialao nerve to restore an arm apparently useless and hopeless. A bottle on* shelf in the surgery contains the sec-ond-hand nerve of a dog, Kept in spirits. The surgeon made a present of it to the patient and fixed it in the right place. In six months feeling returned to the arm, and in less than a year the patient could movo it. During the past yea* Dr. Gosset has performed a great number of nerve operation*. He discussed the results obtained m cases of injured peripheral nerves due to war wounds. The lessons of war surgery, he said, tended mere and more to favour prompt operations, shown them that they had .the right, even the duty to examine daring the preliminary surgical cleaning of the wound, the state of the important Teasels and nerves. This was 6till more necessary if, from the first day, there were signs "of paralysis of a large nervous peripheric trunk. In war surgery, as in civil surgery, immediate suture of the nerves should be completely successful. Delayed surgical treatment might give good functional results in- 40 to 50 per cent, of the cases, according to the nerves, when it had been performed from one month to two years after the wound. 'After that time it should nevertheless b» tried] it might be successful.

Tendon Transplantation. Mr Piatt and Mr Bristow both showed that the results "obtained by nerve surgery had fallen far Bhort of expectations, and they pointed out that the first signs of commencing recovery were no guarantee that such recovery would be effective. As against this the effects of tendon transplantation had been strikingly good- There were cases on record .where nerves had been connected up to other nerves in which the results had been exceptionally good. Mr Bristow spoke, too, of the discouraging results obtained, and drew attention to the danger of patients unconsciously performing trick movements that might deceive the surgeon, but he said in conclusion: "Though a fair and critical survey of the nerve injuries of the war must leave us pe3BimisticaHy inclined, yet there is a brighter side to the picture. War injuries are complicated by sepsis, b.ut for nerve injuries of civil life the prognosis must be vastly better, andthe experience gained of nerve surgery on the scale that has been possible will-help us to crystallise our ideas for the benefit 01 the patient, and for the improvement of the teaching of the student."

A,. Successful Case. Mr Young (Glasgow) took a more favourable view of the situation, and quoted the case of a man who had had a nerve grafted. No good results had followed, and he was discharged from the Army, but he succeeded in getting over to Prance as a motor-driver, and four years after *the operation had a very useful arm. He argued • that nerve tissue should be regarded as similar to other tissue, and contended that if the right conditions were supplied by the surgeon there was reason to hope for good results. Dr. Chasserini (Bome) said: "I think that Elsberg was right when he wrote 'The era of peripheral nerve surgerj is still to come.' " .